Neumonía, Caso clínico

NEUMONÍA CASO CLÍNICO

J. Pavel López Barrera, Residente de segundo año, Infectología Pediátrica

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CASO CLÍNICO NEUMONÍA 

Se trata de paciente adolescente masculino de 14 años de edad el cual cuenta con los siguientes antecedentes: 

HEREDOFAMILIARES 





Ambos padres sanos Dos hermanos sanos

PRE/PERI/POSTNATALES 

Producto de gesta 3, buen control prenatal, normoevolutiv normoevolutivo o

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CASO CLÍNICO NEUMONÍA 

PERSONALES NO PATOLÓGICOS 







Esquema de inmunizaciones acorde a edad Expuesto a tabaquismo pasivo Zoonosis negativa

PERSONALES PA PATOLÓGICOS TOLÓGICOS 



Conocido asmático leve desde los 3 años, última crisis hace 2 años Resto negados

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CASO CLÍNICO NEUMONÍA



¿ QUÉ FACTORES DE RIESGO PARA NEUMONÍA IDENTIFICA ?

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NEUMONÍA PATOGENIA 

FACTORES PREDISPONENTES, INDI VIDUO 

Recién nacido bajo peso al nacer



Falta de lactancia materna exclusiva



Extremos de la vida (65 años)



Estado de inmunización

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NEUMONÍA PATOGENIA 

FACTORES PREDISPONENTES, INDI VIDUO 

Neumopatías



Enfermedades sistémicas



Tabaquismo pasivo



Infección viral reciente

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NEUMONÍA PATOGENIA 

FACTORES PREDISPONENTES, AMBIENTE 

Hacinamiento

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CASO CLÍNICO NEUMONÍA 

PADECIMIENTO ACTUAL 

1 mes de evolución

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CASO CLÍNICO NEUMONÍA 

HOSPITALIZACIÓN HOSPIT ALIZACIÓN SEGUNDO NIVEL, INGRESO 

Peso y talla normales

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NEUMONÍA 

DIAGNÓSTICO

Diagnóstico por labora torio/microbiol torio/microbiología ogía 

Biometría hemática 

Leucocitosis Leucocitos is >15,000 con neutrofilia 80%, sugiere bacteriana

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NEUMONÍA

TRATAMIENTO

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NEUMONÍA

TRATAMIENTO

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CASO CLÍNICO NEUMONÍA 

TRATAMIENTO 







Se Se Se SE

suspende cefotaxima, amikacina y dicloxaci dicloxacilina lina inicia piperacilina/tazobactam (300 mg/kg/día en 4 dosis) inicia fluconazol (10 mg/kg/día en 1 dosis) MANTIENE GANCICLOVIR

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CASO CLÍNICO NEUMONÍA 

TERCER NIVEL, EVOLUCIÓN 



Persistencia de pancitopenia Biometría hemática 







Hemoglobina Plaquetas Neutrófilos

6.9 (transfusión) 42 mil 40

Aspirado de médula ósea

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CASO CLÍNICO NEUMONÍA 

TRATAMIENTO 

Inmunoglobulina intrave intravenosa nosa 



2 g/kg

Metilprednisolona 

30 mg/kg

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CASO CLÍNICO NEUMONÍA 

EVOLUCIÓN



Respuesta clínica y de laboratorio satisfactoria Regresión Regres ión de miocardiopatía dilatada Estabilidad neurológica



Inicia terapia antirretroviral 30 días después de ingreso







Zidovudina + lamivudina + efavirenz 

Carga viral indetectable

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CASO CLÍNICO NEUMONÍA 

DIAGNÓSTICOS FINALES